HomeMy Public PortalAbout8713 GARIBALDI AVE_Building__ 7eAe3eA caaeoa a-85 APPLICATION FOR BUILDING PERM T
COUNTY OF LOS ANGELES BUILDING I
DEPARTMENT OF COUNTY ENGINEER ADD
BUILDING AND SAFETY DIVISION LOCALITY r
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINSSUP'T OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE P. SSED BY
FOR APPLICANT TO FILL IN CON9T.
AD RE88 7/ RJ� �J STATISTICAL CLASSIFICATION SEEKER MAP
CLASS NO.�DWELL UNI T9
LOT NO.P,r[`a - LOT / 8 BLOCK USE ZONE MAP
G . NO. Q
TRACT SPECIAL n
RT NO. OF ■LDSS. /•t
SIZE OF LOT 67 31 NOW ON LOT
NS
UDESTINQ BLDG.OF 4440 1l NO p SLDS. SETBACK FROM
OWNER /�'�" aVAe VIDJ ►✓ Lzf�'5=18�3 FRONT PROF. LING OF (STREET)
TYPE OF EXISTING [[TRACK HIGHWAY YARD = TOTAL
ADDRESS //T'G -J� � WIDTHF M C'
CITY G- .�.+Pl E.L 6 +
ARCHITECTOR TEL. SLDS. [TRACK FROM
ENGINEER s NO. SID¢ PROP. LINE OF STREET
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TE
CONTRACTOR NOL + —
LIC CORNER CUTOFF YES NO
ADDRESS NO
CITY CLASS
SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK
NE ADD ALTER REPAIR DEMOLISH
O
S IZ•E 7 AU,E/i4��9OTT OR ED /� FO M LI E8� -
USE OF
STRUCTURE / [�
SIGNATURE OF
APPLICANT
VALUATION$ S �Q APPROVALS DATE INSPIC R'S SI[KATURE
P.C. L� PMT. iy �� FOUNDATION, LOCATION
FEE$ FEE$ ' 1 FORMS, MATERIALS Ild _
FRAME, FIRE STOPS, _
I HERESY ACKNOWLXOG[ THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE 10 CORRECT AND AGREE TO COMPLY FURNACEI LOCATION
WITH ALL COUNTY ORDINANCES AND STATC LAWS R[OULATING GAS VENT. DUCTS 1
SU ILDI NO CONSTRUCTION, I CERTIFY THAT IN DOING H
T [ WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT.
ITON OF THE LAj" CODE OF THE STATE OF CALIFORNIA R£LaT-
ING TO WORKMEN'S COMPINOATION INSURANCE. f
LATH. EXT.
SIGNATURE OF , HOUSE NUMBER COR-
PERMITTEE RECT ANQ P
ADDRESS FINAL
JOHN F. LEWIS, PRINCIP L T RAL ENGINEER
PLAN CHECK VALIDATION M.o. CASH _ PERMIT VALIDATION cK M.o CASH
7 2 3 A 5
LAC.0 6 7 6 8E3 OCT 2 5 3 A 10 1.0 0- 17
WORKERS'COMPENSATION'DECLARATION
APPLICATION FOR BUI�,DI�VG PERMIT
1 hereby affirm that I have a,certificate of concept. to self
Insure, or a certificate of Workers ComPensatlon Insurance,
6i,&certified ropy thereof{pec 3800, cf) COUNTY OF LOS ANGELES BUILDING AND SAF
Pollry'No. ' , .. .Compar) / L - -- - -
D Certlfied_topy It-h"by.furplshed., FOR APPLICANT TO FILL IN. ADDRESS
Certtfred copy'is flJed Ith the' my building Inspec- BUILDING / �� 4
LJ tion department. ADDRESS
J � _t
Date'.• l 4f �ppI'Cant' � r �IIR. LOCALMY .. A41� 26k&d
NO:
RTl CATS OF EXFIAPT+ON FROM WOf2KERS' NO:OF9a_DGS. - 1EAREST.. .. .
COMPENSATION INSURANCE SF7F OF LOT NOW ON L ST. {J
(Thli section riebd nol-be`4om leted If the permit-Is for one - ASSESSOR
hund*..dollars ($100)qr less T +� BL
LOT NO. MAP BOOK PAGE: PARca
TE
I cedlfy that In.the'perFgrn,'gnce of the work for which this
perinlr Is Jssued, I;shall not employ any person In any manner -
CL
me CL
so-cwto becosubject to the Wold rs'Compersatlon Laws. ADDRESS CCK�MONS
CITY. _ _ _ 71P _
Dale �A�pllcant' ; Ta- v
NOTICE'TO`APPLICANT:,If, aftrar'ntaklnq this Certificate of ARCH r� NO. DISTRICT TYPE j_. FARE BY .
Exemption, you`s6uW become subject to; the, Workers �/Jr � z �T� ZONE
Compensation provisions the labor Gode, you must forth ADDRESS (/Q �J _
with-,comply,with-.such provlslons or this,permit shall. be Ta; STABS 1CAL CLtiSSJF TION APT. JAND0?
deerpO revoked. -- CONTRACTOIz V J-
UCENSED CONTRACTORS DECLARATIQN�., �1 ai,Ss NO_ Z�• DwE1% UNrfS - -
I hereby dfflrm that I Rm licensed undbf prpvblons of Chapter 9 V bitJ NO. CY
(commencing with Section 70Q0)of Dlvblon 3 of the"iteu and -- _ _ -ur_-.-._ MAP
Profs sslons Code, and my license Is.ln full force and eff td. (TTY CLASS -VALIDATION
t BK. PG.
Lltence�um O� LJc CT ` �� - 5TOi8E5 - =S OfE l
VALUAMN.
r ( DESCRIPTION OF WORK �C. `�"�C ) NEW
Contractor ADD $
I am exempt.under Sec. - - _
ER
Ai' �.3466A.
B.BP.C_ for lhb reason 7 REpA1R '�- - -
- - USE OF
_Date - EXISTING BLDG. DEAhOL _ _#.0 °._a ea
. . _
sl9narc, - oEc>iaRnnoN
APPLICANT NO DATE/� o - 87.38
OWNER-BUILDER
Thereby afflrmThat I am exempt from the.Controctors LicenceADDRESS 0 8 7,3 8 5
Law for the.followln-g re<mo.N.(Setflo'n 7031.5, Business and 1.1 4`8'Jr
PrafetsIons Code): _ .__ .. �.
BUILDING
❑• I, as owner of the property, r my employees with ADDRESS - - -
wages as thele sole compensatl6n,will do the work and LOCALITY
the structure Is not Intended or offered for sale(Section
704+1;Business-and.'Professlon .Code) MOVING TEL -
t, as owner of the property, am exclusively contracting CQNTRACTORNO: `
with-licensed contractors to constructthb'project (Sec- EA `
tlon 7044, Business and Professions Code).
CONSTRUCTION LENDING-AC-134CY YARD FIWY TOTAL PROP. UNE WIDTH
I hereby`affirm that there Is d constructlon lending agency for.
thep»rformance of the work for which this permit Is Issued r - -
(Sec. 3097, Clv. C). '
P.L.
Lender's Name R
$ D LDMA Ref.
?- tentless Address - Perms FeeI.certify that I-have read this application and state.that.the Issuance Fee S LDMA P/Cabove Inforrtwtlon bmrrect. I agree ro comply wHh all Countyee 1 -
ordln_ances qnd State laws relating to_bullding.cor4tructlon,
thorize representatives of this County to enter Total Fee !
LDAAk Perm.
upo e a loved rty for Inspection purpose.
lel._ ss eEvEtU FOR E)IJ4.ANAT0I[v L.Ar+auwae
o - Signature of Applkxn.t or Agent